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Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias
The extracellular electrogram is caused by transmembrane currents that flow into extracellular space during propagation of the electrical impulse. Electrograms are usually recorded in unipolar or bipolar mode that have different characteristics, but provide complementary information. Both recording...
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916598/ https://www.ncbi.nlm.nih.gov/pubmed/31609005 http://dx.doi.org/10.1111/pace.13817 |
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author | de Bakker, Jacques MT |
author_facet | de Bakker, Jacques MT |
author_sort | de Bakker, Jacques MT |
collection | PubMed |
description | The extracellular electrogram is caused by transmembrane currents that flow into extracellular space during propagation of the electrical impulse. Electrograms are usually recorded in unipolar or bipolar mode that have different characteristics, but provide complementary information. Both recording modes have specific advantages, but also suffer from disadvantages. Techniques to circumvent some of the weaknesses are reviewed. The origin of remote and fractionated deflections and their relation with electrode characteristics are discussed. Epicardial and endocardial sites of origin and breakthrough sites as well as the effect of fatty tissue on extracellular electrograms are presented. Induction of tachycardia to assess the arrhythmogenic area is not always possible because of hemodynamic instability of the patient. Techniques to assess sites with high reentry vulnerability without induction of arrhythmias are outlined such as activation‐repolarization mapping and decremental stimulation. Pitfalls of substrate mapping and techniques to avoid them as omnipolar mapping and characterization of complex electrograms by entropy are presented. Technical aspects that influence electrogram morphology as electrode size, filtering, contact force, and catheter position are delineated. Data from the various publications suggest that a combination of unipolar and bipolar electrogram analysis techniques is helpful to optimize determination of target sites for ablation. |
format | Online Article Text |
id | pubmed-6916598 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-69165982019-12-23 Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias de Bakker, Jacques MT Pacing Clin Electrophysiol Review The extracellular electrogram is caused by transmembrane currents that flow into extracellular space during propagation of the electrical impulse. Electrograms are usually recorded in unipolar or bipolar mode that have different characteristics, but provide complementary information. Both recording modes have specific advantages, but also suffer from disadvantages. Techniques to circumvent some of the weaknesses are reviewed. The origin of remote and fractionated deflections and their relation with electrode characteristics are discussed. Epicardial and endocardial sites of origin and breakthrough sites as well as the effect of fatty tissue on extracellular electrograms are presented. Induction of tachycardia to assess the arrhythmogenic area is not always possible because of hemodynamic instability of the patient. Techniques to assess sites with high reentry vulnerability without induction of arrhythmias are outlined such as activation‐repolarization mapping and decremental stimulation. Pitfalls of substrate mapping and techniques to avoid them as omnipolar mapping and characterization of complex electrograms by entropy are presented. Technical aspects that influence electrogram morphology as electrode size, filtering, contact force, and catheter position are delineated. Data from the various publications suggest that a combination of unipolar and bipolar electrogram analysis techniques is helpful to optimize determination of target sites for ablation. John Wiley and Sons Inc. 2019-11-18 2019-12 /pmc/articles/PMC6916598/ /pubmed/31609005 http://dx.doi.org/10.1111/pace.13817 Text en © 2019 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals, Inc. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Review de Bakker, Jacques MT Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias |
title | Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias |
title_full | Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias |
title_fullStr | Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias |
title_full_unstemmed | Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias |
title_short | Electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias |
title_sort | electrogram recording and analyzing techniques to optimize selection of target sites for ablation of cardiac arrhythmias |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6916598/ https://www.ncbi.nlm.nih.gov/pubmed/31609005 http://dx.doi.org/10.1111/pace.13817 |
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